NHA: BILLING AND CODING 2024 UPDATE
QUESTIONS AND VERIFIED ANSWERS EXAM
PRACTICE GRADE A+
1. Which of the following is an advantage of electronic claim submission?
a. Claims are expedited
1. When should a billing and coding specialist initiate the collection of the
information needed to process a patient's insurance claim form?
a. When the patient contacts the provider's office and schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee.
Which of the following scenarios warrants the use of a modifier?
a. Splinting of the fourth digit on the left foot
1. A billing and coding specialist is reviewing a provider's documentation for a
patient who underwent repair of multiple wounds to the face and trunk. The
provider coded repair of all wounds individually. The specialist should recognize
that the provider should have applied which of the following concepts to the
documentation of the repair for this patient's wounds?
a. Wounds should be grouped by anatomic site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and
bony structure?
a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers
that a third-party payer paid a claim but applied it to the incorrect provider. The
third-party payer will reimburse the payment once the improperly paid funds are
recouped. Which of the following terms is used to describe this claim?
a. Suspended
1. For which of the following reasons should a claim be resubmitted?
a. The claim requires an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging report.
The specialist should expect the report to include which of the following?
a. Outstanding balances organized by date
1. A billing and coding specialist discovers that one private payer has not
reimbursed the provider for any claims submitted in the past year. Clean claims
have been submitted to the payer and have been acknowledged. Which of the
following entities should the specialist contact to report the payer's failure to
submit timely reimbursement?
a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code?
a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the
following?
a. Telemedicine
, 1. Which of the following pieces of guarantor information is required when
establishing a patient's financial record?
a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a
patient's health information is protected?
a. Using data encryption software on office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a
denial by a third-party payer for lack of medical necessity. Which of the following
should the specialist include with the letter to indicate medical necessity?
a. Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under both
parents' insurance policies. The child's father was born on 10/1/1980 and their
mother was born on 10/2/1921. Which of the following statements is true
regarding the primary policy holder for the child?
a. The father is the primary policy holder because his birthday falls first in the calendar
year
1. A billing and coding specialist is processing a claim for a patient who broke
their arm while repairing cars at their workplace. There is no nerve damage, the
arm is placed in a cast for 6 weeks, and the patient is cleared to return to work in
6 weeks. Which of the following types of workers' compensation applies to this
patient?
a. Temporary disability
1. Which of the following information is required on a patient account required?
a. Name and address of guarantor
1. A billing and coding specialist is reviewing a delinquent claim. Which of the
following actions should the specialist take first?
a. Verify the age of the account
1. A patient presents to a provider's office with difficulty speaking, facial
drooping, and an inability to close their left eye. They are diagnosed with Bell's
palsy. A billing and coding specialist should report which of the following ICD-10-
CM codes?
a. G51.0
1. A patient has a breast biopsy with the placement of a clip. After the biopsy is
determined to be malignant, the patient elects for a mastectomy during the global
period of the biopsy. Which of the following modifiers should a billing and coding
specialist use to report the mastectomy?
-58
1. A billing and coding specialist is reviewing a report from the clearinghouse
after submitting electronic claims and notices that one claim was rejected due to
missing demographic information. Which of the following actions should the
specialist take?
a. Resubmit an updated claim
1. A billing and coding specialist is reviewing a remittance advice from Medicare
and notice that the amount paid for a procedure is less than the contracted
amount. Which of the following is potential reason for the reduced amount of
payment?
QUESTIONS AND VERIFIED ANSWERS EXAM
PRACTICE GRADE A+
1. Which of the following is an advantage of electronic claim submission?
a. Claims are expedited
1. When should a billing and coding specialist initiate the collection of the
information needed to process a patient's insurance claim form?
a. When the patient contacts the provider's office and schedules an appointment
1. A billing and coding specialist is reviewing modifier use with a new employee.
Which of the following scenarios warrants the use of a modifier?
a. Splinting of the fourth digit on the left foot
1. A billing and coding specialist is reviewing a provider's documentation for a
patient who underwent repair of multiple wounds to the face and trunk. The
provider coded repair of all wounds individually. The specialist should recognize
that the provider should have applied which of the following concepts to the
documentation of the repair for this patient's wounds?
a. Wounds should be grouped by anatomic site and coded in order of complexity
1. Which of the following terms describe the removal of the eye, adnexa, and
bony structure?
a. Exenteration
1. A billing and coding specialist is reviewing delinquent claims and discovers
that a third-party payer paid a claim but applied it to the incorrect provider. The
third-party payer will reimburse the payment once the improperly paid funds are
recouped. Which of the following terms is used to describe this claim?
a. Suspended
1. For which of the following reasons should a claim be resubmitted?
a. The claim requires an attachment to support medical necessity
1. A billing and coding specialist is preparing an account receivable aging report.
The specialist should expect the report to include which of the following?
a. Outstanding balances organized by date
1. A billing and coding specialist discovers that one private payer has not
reimbursed the provider for any claims submitted in the past year. Clean claims
have been submitted to the payer and have been acknowledged. Which of the
following entities should the specialist contact to report the payer's failure to
submit timely reimbursement?
a. State Insurance Commissioner's office
1. Which of the following is an example of a diagnostic category code?
a. I10
1. The star symbol in the CPT coding manual is used to indicate which of the
following?
a. Telemedicine
, 1. Which of the following pieces of guarantor information is required when
establishing a patient's financial record?
a. Phone number
1. Which of the following actions by a billing and coding specialist ensures a
patient's health information is protected?
a. Using data encryption software on office workstations
1. A billing and coding specialist is preparing an appeal letter in response to a
denial by a third-party payer for lack of medical necessity. Which of the following
should the specialist include with the letter to indicate medical necessity?
a. Medical record documentation
1. A child is brought into a facility by their mother. The child is cover under both
parents' insurance policies. The child's father was born on 10/1/1980 and their
mother was born on 10/2/1921. Which of the following statements is true
regarding the primary policy holder for the child?
a. The father is the primary policy holder because his birthday falls first in the calendar
year
1. A billing and coding specialist is processing a claim for a patient who broke
their arm while repairing cars at their workplace. There is no nerve damage, the
arm is placed in a cast for 6 weeks, and the patient is cleared to return to work in
6 weeks. Which of the following types of workers' compensation applies to this
patient?
a. Temporary disability
1. Which of the following information is required on a patient account required?
a. Name and address of guarantor
1. A billing and coding specialist is reviewing a delinquent claim. Which of the
following actions should the specialist take first?
a. Verify the age of the account
1. A patient presents to a provider's office with difficulty speaking, facial
drooping, and an inability to close their left eye. They are diagnosed with Bell's
palsy. A billing and coding specialist should report which of the following ICD-10-
CM codes?
a. G51.0
1. A patient has a breast biopsy with the placement of a clip. After the biopsy is
determined to be malignant, the patient elects for a mastectomy during the global
period of the biopsy. Which of the following modifiers should a billing and coding
specialist use to report the mastectomy?
-58
1. A billing and coding specialist is reviewing a report from the clearinghouse
after submitting electronic claims and notices that one claim was rejected due to
missing demographic information. Which of the following actions should the
specialist take?
a. Resubmit an updated claim
1. A billing and coding specialist is reviewing a remittance advice from Medicare
and notice that the amount paid for a procedure is less than the contracted
amount. Which of the following is potential reason for the reduced amount of
payment?
